Wang Yang, Jin Hua, Yang Hui, Zhao Yang, Qian Yi, Yu Dehua, Fang Hai
Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.
Shanghai General Practice and Community Health Development Research Center, Shanghai, China.
J Glob Health. 2025 Jan 10;15:04007. doi: 10.7189/jogh.15.04007.
While research in multiple countries confirms that primary care functional features significantly improve patient health, China's primary care system differs markedly due to unique structural and contextual factors. This study aims to measure and explore the functional features experienced by patients received family doctor contract service in the past year, evaluating the impacts and pathways of these primary care features on health outcomes.
We employed a mixed-methods explanatory sequential design. In the quantitative phase, we randomly selected 2118 residents from 12 primary care institutions. The intensity of functional features was assessed using the Person-Centered Primary Care Measure (PCPCM), and their association with levels of EuroQol Visual Analogue Scale (EQ VAS) was evaluated through multilevel modelling. In the qualitative phase, a qualitative description approach was used, conducting 24 focus groups with a total of 85 patients to gather in-depth information about their experiences with functional features and perceived health impacts. Finally, the quantitative and qualitative data were integrated using meta-synthesis and joint display methods to validate, interpret, and expand the results.
The average PCPCM score was 3.65, with subdomain scores ranging from 3.39 to 3.83. Qualitative findings confirmed the quantitative results regarding the intensity and manifestation of features like accessibility, coordination, and relationship-building. However, discrepancies were noted in features such as comprehensiveness, integration, and family and community context. Additionally, two new functional features, 'being appreciated' and 'being cared for,' were identified. The quantitative results also showed that higher PCPCM scores were positively associated with EQ VAS levels (odds ratio (OR) = 1.18; 95% confidence interval (CI) = 1.03-1.35, P < 0.001). Furthermore, qualitative results revealed six key pathways supporting the beneficial effects of local primary care functional features on health maintenance and improvement.
This study demonstrates high functional scores for Shanghai's family doctor services and highlights a positive association between primary care functionality and population health. These features and their health benefits are deeply shaped by the local social and health care context. This confirms the progress of Shanghai's primary care development and underscores the need for further exploration of primary care functional features across China, along with the development of tools tailored to local conditions to better measure and improve primary care quality and health outcomes.
primary healthcare; primary care; quality measurement; population health; mixed method research; China.
虽然多个国家的研究证实初级保健功能特征能显著改善患者健康，但由于独特的结构和背景因素，中国的初级保健系统存在显著差异。本研究旨在衡量和探索过去一年接受家庭医生签约服务的患者所体验到的功能特征，评估这些初级保健特征对健康结果的影响及途径。
我们采用了混合方法的解释性序列设计。在定量阶段，我们从12个基层医疗机构中随机抽取了2118名居民。使用以患者为中心的初级保健测量工具（PCPCM）评估功能特征的强度，并通过多层次建模评估其与欧洲五维度健康量表视觉模拟评分（EQ - VAS）水平的关联。在定性阶段，采用定性描述方法，对85名患者进行了24个焦点小组访谈，以收集他们对功能特征体验及感知健康影响的深入信息。最后，使用元综合和联合展示方法整合定量和定性数据，以验证、解释和扩展结果。
PCPCM平均得分为3.65，各子领域得分在3.39至3.83之间。定性研究结果证实了关于可及性、协调性和关系建立等特征的强度和表现的定量结果。然而，在全面性、整合性以及家庭和社区背景等特征方面存在差异。此外，还识别出了两个新的功能特征，即“被欣赏”和“被关怀”。定量结果还表明，PCPCM得分越高与EQ - VAS水平呈正相关（优势比（OR）= 1.18；95%置信区间（CI）= 1.03 - 1.35，P < 0.001）。此外，定性结果揭示了支持当地初级保健功能特征对健康维持和改善产生有益影响的六个关键途径。
本研究表明上海家庭医生服务的功能得分较高，并突出了初级保健功能与人群健康之间的正相关关系。这些特征及其对健康的益处深受当地社会和医疗背景的影响。这证实了上海初级保健发展的进展，并强调需要在中国进一步探索初级保健功能特征，同时开发适合当地情况的工具，以更好地衡量和提高初级保健质量及健康结果。
初级卫生保健；初级保健；质量测量；人群健康；混合方法研究；中国
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